The World Bank Report No: ISR8996 Implementation Status & Results Kyrgyz Republic Health & Social Protection Project (P084977) Public Disclosure Copy Operation Name: Health & Social Protection Project (P084977) Project Stage: Implementation Seq.No: 10 Status: ARCHIVED Archive Date: 29-Dec-2012 Country: Kyrgyz Republic Approval FY: 2006 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 15-Dec-2005 Original Closing Date 30-Jun-2011 Planned Mid Term Review Date Last Archived ISR Date 26-Jun-2012 Effectiveness Date 08-Jun-2006 Revised Closing Date 30-Jun-2014 Actual Mid Term Review Date 28-May-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) The original project development objectives were amended to include two additional specific objectives (objectives [d] and [e] below) under the proposed additional financing. The revised objectives are to improve health status in the Kyrgyz Republic: (a) by improving access, financial protection, efficiency, equity and fiduciary performance in the Kyrgyz health sector; (b) to ensure sufficient and reliable financing for the health sector; (c) to strengthen the targeting of social benefits by developing effective administration and information management systems to improve access to social services in general; (d) protecting and improving health and nutritional status of particularly vulnerable populations in the Kyrgyz Republic in the face of food price shocks, by providing nutritional supplements and nutrition education to pregnant/lactating women and infants/young children; and (e) helping poor Kyrgyz families manage and mitigate the impact of food price shocks and protect consumption (general and food consumption) by scaling up and strengthening targeted cash transfers. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1: Support for the Manas Taalimi Health Reform Program and its associated Program of 34.10 Work Public Disclosure Copy Component 2: Strengthening the Administrative System of the Ministry of Labor and Social Protection 7.30 Component 3: Protecting Health and Nutritional Status 3.60 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating High Page 1 of 8 The World Bank Report No: ISR8996 Implementation Status Overview Progress towards the Project Development Objectives is good although there are a few areas, mainly in financial management and implementation capacity that may affect PDOs achievement. To reinforce overall implementation and management, there is a need to further strengthen the capacity of the Ministry of Health (MOH) in the areas of planning, coordination, procurement and financial management as part of ongoing strengthening of country systems. Public Disclosure Copy A Health Sector Senior Policy Seminar took place November 29-30, 2012. The Seminar was well attended by high level officials from the Government and development partners, including Parliamentarians of the Jogorku Kenesh in particular the health and social committee; Senior policy makers in the President´s Administration, Prime Minister, Ministry of Finance, Ministry of Labor and Social Affairs, Ministry of Health and Mandatory Health Insurance Fund; Oblast governors and mayors of Bishkek and Osh cities; Representatives of selected health facilities; Representatives of selected NGOs; and Representatives of international organizations active in health SWAp. The objectives of the seminar were to (a) draw policy lessons on how to accelerate health gain in Kyrgyzstan based on international experience around two main themes: (i) strengthening universal health coverage; (ii) modernizing the delivery of health services; and (b) provide an opportunity for senior policy makers to interact with health sector experts in a formal as well as informal context in order to build consensus on next generation health reform issues in Den Sooluk. SPS highlighted: 1. That reforms in health sector and introduction of new technologies usually cost more; that fiscal space for further increase of expenditures for health is limited and therefore most of health gains will have to come from efficiency in public spending; current targeting for basic package is inefficient; and that government should start disease management programs which are not expensive but result in high health gains and contribute to productivity, stability and trust in government actions among population. The XIII Joint Annual Review (JAR, Dec. 3-7, 2012) was successfully organized by MOH. Apart from discussing progress with implementation of reforms supported under Manas Taalimi, the JAR focused on the Den Sooluk (DS) Strategy (2012 – 2016). The JAR was attended by a broad spectrum of government and non-government stakeholders. Presentations focused on proposed intended outcomes/results and 2013 planned activities in the four priority areas (maternal/child health care, cardiovascular diseases, Tuberculosis, HIV/AIDS) planned under the Den Sooluk. Discussions also took place on cross-cutting issues including: health financing, public health, service delivery, and governance. Lastly, discussions also covered the implementation arrangements suitable for the SWAp2 and Monitoring and Evaluation. In the area of Social Protection: The Ministry of Social Development is gradually implementing the social assistance beneficiary registry and corporate information management system. All district level Social Protection offices have been linked in a network with the central level database. Staffs at the central and down to the district level have been trained in the use of the information system. Data entry began in October 2012 and is continuing. Locations No Location data has been entered Results Project Development Objective Indicators Public Disclosure Copy Page 2 of 8 The World Bank Report No: ISR8996 Indicator Name Core Unit of Measure Baseline Current End Target Health statistics show improvements on overall Text Value Annual health statistics Progress achieved in key Greater progress health status health outcomes Progress/Infant mortality Public Disclosure Copy comparable Date 11-May-2004 11-Dec-2012 30-Jun-2014 Comments ON TRACK. Reduced IMR from 38 to 21.1; Under 5 mortality rate decreased: 72 per 10,000 in 1990 to 38 per 10,000 in 2012 Maintain or increase total spending on the Text Value 0 NO DATA. Sustain UMB as a share of the poverty gap Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 Comments Original indicator continued No exact data available; with AF2 pending new software by February 2013 Nutriotional status measured as a percentage Text Value n/a Coverage of 97% achieved in >60% of anemic children age 6-24 by nutritional Talas region. >75% supplement and children under 5 with Vitamin Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 A Comments Revised with AF2 ON TRACK. Project achieved uninterrupted supply of micro nutrients and flour fortification goods. Talas region shows coverage of 97% (247,500 children). Detailed analysis to be covered in survey in 2013. Decreased percent of anemic pregnant women Text Value 40% Supply of micronutrients and 20% flour fortification materials purchased and distributed. Date 11-May-2011 11-Dec-2012 30-Jun-2014 Comments New PDO indicator with AF2 Indicator not available in routine health statistics will Public Disclosure Copy require special survey in 2013. Intermediate Results Indicators Page 3 of 8 The World Bank Report No: ISR8996 Indicator Name Core Unit of Measure Baseline Current End Target Percent of adults and children with HIV Percentage Value 42.50 57.60 100.00 receiving antiretroviral combination therapy Date 28-May-2008 11-Dec-2012 30-Jun-2014 Public Disclosure Copy Comments Original indicator continued ON TRACK. 655 out of 945 with AF2; there were no adults/children who were baseline in 2004; baseline prescribed ART, including 232 from MTR children Increased percentage of pregnant women Percentage Value 28.50 54.20 100.00 living with HIV who received antiretroviral Date 28-May-2008 11-Dec-2012 30-Jun-2014 (ARV) to reduce the risk of MTCT Comments Original indicator continued ON TRACK. 26 our of 45 with AF2; there were no pregnant women are baseline in 2004; baseline receiving ART. from MTR Improved fiduciary performance in the Kyrgyz Text Value n/a Financial audit is 4 months Financial audit in time of good health sector overdue; FMRs are being quality; FMRs timely submitted without delays submitted and of good quality Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 Comments Revised with AF2 (more ON TRACK. Audits came as specific and measurable qualified audits despite good indicator) progress. Reports are satisfactory to the bank. Acton plan to strengthen FMdeveloped. Decrease percent of out-of-pocket health Text Value 7.1/5.5 percent 4.8/2.9 percent 4.0/4.0 percent expenditures in total household consumption, Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 poorest / second quintiles Comments Original indicator revised with ON TRACK. Period AF2 (clarified and target value 2004-2010 OOP reduced for added) two poorest quintiles Government spending on non-salary recurrent Text Value 0.96% 0.96% Sustain costs as a percentage of GDP Date 28-May-2008 11-Dec-2012 30-Jun-2014 Public Disclosure Copy Comments Revised with AF2. Baseline at ON TRACK. 2011 data show MTR slight crowding of total public expenditures with salary increase. Percent of population not seeking care when Text Value 4.4% Estimated at 4.4% needed due to geographic and financial Date 11-May-2011 11-Dec-2012 30-Jun-2014 reasons Comments New indicator with AF2 IN PROGRESS. Indicator not TBD included in Den Sooluk; will Page 4 of 8 The World Bank Report No: ISR8996 need special survey envisaged under Den Sooluk studies for 2013. Immunization coverage by age 2+ with basic Text Value 99.0% 97.8% >97% Public Disclosure Copy vaccines Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 Comments Original indicator continued GOOD PROGRESS. Data with AF2 but target value show slight improvements in added vaccination coverage. Further assessment of exclusions needed and planned for 2014. Pilot community based mental health to Text Value Initiated Action plan on mental health Piloted contribute to strengthening social cohesion developed and implementation initiated Date 11-May-2011 11-Dec-2012 30-Jun-2014 Comments New indicator with AF2 GOOD PROGRESS. Good progress made in developing National action plan with consultation of all stakeholders, including NGOs. Establish unified perinatal Center for all Text Value n/a Selection process of firm for Completed communities in the 3 south oblasts to increase development of Master Plan efficiency and social reconcilation ongoing Date 11-May-2011 11-Dec-2012 30-Jun-2014 Comments New indicator with AF2 SOME DELAYS. Due to slow ratification process of the project, it will not be possible to complete perinatal centers as planned. Instead MoH is doing Prospective Plans for 3 oblasts in the South to determine investments Public Disclosure Copy beyond only maternal center. Maintain or increase in total coverage of the Text Value 352,146 Sustained. Sustained UMB program Date 01-Dec-2011 11-Dec-2012 30-Jun-2014 Comments Indicator was revised with ON TRACK. Still there are AF2 and moved from PDO to some fluctuations in the Intermediate indicators number of program beneficiaries; needs to be checked. Page 5 of 8 The World Bank Report No: ISR8996 Automated management information system Text Value No ON TRACK. Improved (national beneficiary database) designed, Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 effectively implemented, and providing timely Comments Original indicator continued ON TRACK. Systemic andaccurate data to analyze, design and Public Disclosure Copy monitor social policy with AF2 approach is needed to develop modern registry system and this will also be supported by the proposed Project (SWAp2). Current software broadly installed with many functional deficiencies. Reduced turn-around time for registering Text Value n/a 8 days 5 days families for potential eligibility under the UMB Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 program Comments Original indicator continued ON TRACK. It is rated as on with AF2, but target value track despite the fact that no added actual progress has been made on this in view of incomplete roll-out ofthe beneficiary registry. New registry under preparation. Percentage of children under 5 receiving a Text Value n/a 70% 80% dose of Vitamin A Date 11-Dec-2012 30-Jun-2014 Comments Original indicator continued GOOD PROGRESS. Vitamin with AF2 A included in sprinkles nutritional supplement purchased under AF2 Percent of anemic pregnant women who are Text Value n/a n/a 80% prescribed and receive iron-containing tablets Date 11-May-2011 11-Dec-2012 30-Jun-2014 Comments New indicator with AF2 to DELAYED. HMIS no longer measure new activities reports this indicator. Survey will be conducted to estimate progress in 2013. Public Disclosure Copy Health personnel receiving training (number) Number Value 0.00 0.00 Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 Comments Original indicator continued Data on training to be no target with AF2. It is core indicator. collected for next ISR update Health facilities constructed, renovated, and/or Number Value 0.00 0.00 equipped (number) Date 14-Dec-2004 11-Dec-2012 30-Jun-2014 Page 6 of 8 The World Bank Report No: ISR8996 Comments Original indicator continued Prospective or master plans no target with AF2 upon which facilities will be constructed/renovated will be completed by May 2013. Public Disclosure Copy Data on Financial Performance (as of 06-Dec-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P084977 IDA-49570 Effective 09-Jun-2011 22-Nov-2011 28-Aug-2012 30-Jun-2014 30-Jun-2014 P084977 IDA-H1970 Effective 15-Dec-2005 10-Mar-2006 08-Jun-2006 30-Jun-2011 30-Jun-2013 P084977 IDA-H3910 Closed 12-Jun-2008 25-Jun-2008 31-Jul-2008 30-Jun-2011 31-Dec-2011 P084977 IDA-H7000 Effective 09-Jun-2011 22-Nov-2011 28-Aug-2012 30-Jun-2014 30-Jun-2014 P084977 TF-11265 Closed 25-Jan-2012 26-Mar-2012 26-Mar-2012 31-Mar-2012 31-Mar-2012 P084977 TF-11531 Closed 30-Jan-2012 26-Mar-2012 26-Mar-2012 30-Jun-2012 30-Jun-2012 P084977 TF-56540 Closed 08-Jun-2006 08-Jun-2006 08-Jun-2006 28-Feb-2011 28-Feb-2011 P084977 TF-56799 Closed 14-Nov-2006 14-Nov-2006 14-Nov-2006 28-Feb-2011 28-Feb-2011 P084977 TF-90119 Closed 18-Aug-2007 18-Aug-2007 18-Aug-2007 28-Feb-2011 28-Feb-2011 P084977 TF-91613 Closed 04-Jul-2008 04-Jul-2008 04-Jul-2008 31-Jan-2011 31-Jan-2011 P084977 TF-97870 Closed 29-Mar-2011 06-Jun-2011 06-Jun-2011 30-Jun-2011 30-Jun-2011 P084977 TF-98740 Closed 28-Mar-2011 06-Jun-2011 06-Jun-2011 30-Jun-2011 30-Jun-2011 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P084977 IDA-49570 Effective USD 13.20 13.20 0.00 0.00 12.94 0.00 P084977 IDA-H1970 Effective USD 15.00 15.00 0.00 15.71 0.32 105.00 P084977 IDA-H3910 Closed USD 6.00 6.00 0.00 5.71 0.00 95.00 P084977 IDA-H7000 Effective USD 10.80 10.80 0.00 7.05 3.56 65.00 Public Disclosure Copy P084977 TF-11265 Closed USD 2.94 3.07 0.00 3.03 0.00 99.00 P084977 TF-11531 Closed USD 1.12 1.12 0.00 1.12 0.00 100.00 P084977 TF-56540 Closed USD 12.82 11.35 0.01 12.05 0.00 106.00 P084977 TF-56799 Closed USD 3.00 3.00 0.00 3.00 0.00 100.00 P084977 TF-90119 Closed USD 12.54 14.31 0.00 12.25 0.00 86.00 P084977 TF-91613 Closed USD 1.00 3.72 0.00 3.72 0.00 100.00 P084977 TF-97870 Closed USD 1.12 1.12 0.00 1.12 0.00 100.00 P084977 TF-98740 Closed USD 1.52 1.43 0.00 1.50 0.00 105.00 Page 7 of 8 The World Bank Report No: ISR8996 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation It was agreed with MOH and Development Partners to have one Joint Annual Review (JAR) per year rather than 2 JARs and to have 3 technical meetings per year to support implementation of DS. Restructuring History Board Approved on 23-Jun-2008, Board Approved on 26-Jun-2008, Level two Approved on 31-May-2011, Level two Approved on 23-Sep-2011 Related Projects P112142-Health & Social Protection Project, P125470-Additional Financing 2 Kyrgyz Health and Social Protection Public Disclosure Copy Page 8 of 8